Idiopathic ventricular arrhythmia arising from the mitral annulus

Q: What are the key findings of this study?

Radiofrequency catheter ablation successfully eliminated mitral annular ventricular arrhythmias, which accounted for 5% of idiopathic cases, with no recurrences over 21 months.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Symptomatic idiopathic ventricular tachycardia or premature ventricular contraction (n=352). Intervention: Radiofrequency catheter ablation (RFCA) and ECG analysis. Primary outcome: Prevalence of MAVT/PVC among patients with symptomatic IVT/PVC.

Hiroshi Tada; Sachiko Ito; Shigeto Naito; Kenji Kurosaki; Shoichi Kubota; Aiko Sugiyasu; Taketsugu Tsuchiya; Kohei Miyaji; Minoru Yamada; Yasunori KUTSUMI; Shigeru Oshima; Akihiko Nogami; Koichi Taniguchi

doi:10.1016/j.jacc.2004.12.025

March 1, 2005Journal of the American College of Cardiology

Idiopathic ventricular arrhythmia arising from the mitral annulus

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Key result

Radiofrequency ablation eliminates mitral annular ventricular arrhythmias, comprising ~5% of idiopathic cases, without recurrence.

n=352

Why the study?

Recent case reports described patients with ventricular arrhythmias originating from the mitral annulus, but their prevalence and characteristics remained unclear.

Key Points

To determine the prevalence, electrocardiographic characteristics, and radiofrequency catheter ablation outcomes of idiopathic ventricular arrhythmias originating from the mitral annulus.
Analyzed electrocardiographic patterns, electrophysiological testing, and radiofrequency catheter ablation outcomes in 352 patients with symptomatic idiopathic ventricular tachycardia or premature ventricular contractions.
Followed patients for an average duration of 21 ± 15 months following catheter ablation to monitor for arrhythmia recurrence.
Mitral annular origin was identified in 5% (19/352) of patients, originating from anterolateral (58%), posteroseptal (31%), and posterior (11%) sites.
All patients exhibited an S-wave in lead V6, with anterolateral and posterior origins displaying significantly longer QRS duration than posteroseptal sites (p < 0.001) alongside distinct QRS polarities across limb and precordial leads.
Radiofrequency catheter ablation achieved acute elimination of the arrhythmia in 100% (19/19) of patients, with zero recurrences during 21 ± 15 months of follow-up.

Study Design

Type

Observational (n=352)

Structured PICO

P

Population

352 patients with symptomatic idiopathic ventricular tachycardia (IVT) or premature ventricular contraction (PVC)

I

Intervention

Electrocardiographic (ECG) analysis, electrophysiologic investigation, and radiofrequency catheter ablation (RFCA)

O

Outcome

Prevalence and ECG characteristics of MAVT/PVC, and recurrence after RFCA

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Implication

Mitral annular VT/PVC is a rare (5%) but distinct subgroup of idiopathic ventricular arrhythmias that can be accurately localized by ECG and successfully eliminated with radiofrequency catheter ablation.

Abstract

OBJECTIVES: We sought to clarify the prevalence and characteristics of idiopathic ventricular tachycardia or premature ventricular contraction originating from the mitral annulus (MAVT/PVC). BACKGROUND: Recent case reports have presented patients with MAVT/PVC. METHODS: Electrocardiographic (ECG) characteristics and the results of electrophysiologic investigation and radiofrequency catheter ablation (RFCA) were analyzed in 352 patients with symptomatic idiopathic ventricular tachycardia (IVT)/premature ventricular contraction (PVC). RESULTS: Nineteen cases of IVT/PVC (5%) represented MAVT/PVC. Of these, 11 (58%) originated from the anterolateral portion of the mitral annulus (AL-MAVT/PVC), and 2 (11%) arose from the posterior portion (Pos-MAVT/PVC). The remaining six cases of MAVT/PVC (31%) had posteroseptal origin (PS-MAVT/PVC). In all patients, an S-wave was present in lead V(6). The QRS polarity in inferior leads and leads I and aVL was useful for differentiating AL-MAVT/PVC from Pos-MAVT/PVC or PS-MAVT/PVC. The Pos-MAVT/PVC had an Rs pattern in lead I and an R pattern in lead V(1), whereas PS-MAVT/PVC invariably had an R pattern in lead I and a negative QRS component in lead V(1). The AL-MAVT/PVC and Pos-MAVT/PVC showed a longer QRS duration than the PS-MAVT/PVC (p < 0.001), and all had late-phase "notching" of the QRS complex in inferior leads. In all patients, RFCA eliminated MAVT/PVC, with no recurrences during follow-up for 21 +/- 15 months. CONCLUSIONS: Mitral annular VT/PVC is a rare but distinct subgroup of IVT/PVC. MAVT/PVC origin could be determined by ECG analysis. The AL and PS sites of the MA were preferential.

Discussion

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Cite This Study

Tada et al. (2005) conducted an observational in Symptomatic idiopathic ventricular tachycardia or premature ventricular contraction (n=352). Radiofrequency catheter ablation (RFCA) and ECG analysis was evaluated on Prevalence of MAVT/PVC among patients with symptomatic IVT/PVC. Radiofrequency catheter ablation successfully eliminated mitral annular ventricular arrhythmias, which accounted for 5% of idiopathic cases, with no recurrences over 21 months.

synapsesocial.com/papers/6a0988057a6e434167969237 https://doi.org/10.1016/j.jacc.2004.12.025

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Idiopathic ventricular arrhythmia arising from the mitral annulus

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Idiopathic ventricular arrhythmia arising from the mitral annulus

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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